Big Results for Louisiana's Smallest Patients

The OB nurses at Woman’s Hospital in Baton Rouge knew something was wrong. Day after day, they reviewed the current deliveries and none of the mothers had reached their 40th week of pregnancy. More worrisome, the nurses knew that many women were delivering early for non-medical reasons. Frequently, their babies wound up in the neonatal intensive care unit (NICU).

“We knew the problems the babies would have,” says Cheri Johnson, RNC-OB, BSN, Director of Obstetrical Services, “but we didn’t have data.” The nurses needed numbers to convince providers to make changes, and they got them by joining IHI’s Perinatal Improvement Community. Today, there are no elective deliveries before 39 weeks at Woman’s, and NICU admissions are down 23 percent.

Throughout Louisiana, about 15 percent of babies arrive early. The March of Dimes planned to give the state a grade of “F” around the time Bruce D. Greenstein became Secretary of Louisiana’s Department of Health and Hospitals in 2010. The state launched the Birth Outcomes Initiative (BOI), which included the 39 Week Initiative to eradicate elective preterm deliveries. Greenstein decided “it was overwhelmingly compelling and part of my responsibility” to make this work a priority.

Greenstein and his BOI team met with leaders from Woman’s Hospital and learned about IHI’s perinatal initiative. Next, they partnered with the Louisiana Hospital Association and the March of Dimes and visited the state’s major birthing hospitals, urging them to collaborate with IHI and voluntarily end elective preterm deliveries.

The results have been dramatic: elective deliveries before 39 weeks are now banned at all 58 Louisiana birthing hospitals, and the earliest adopters reported 20 percent reductions in NICU admissions in the first six months. “The progress we’re making in Louisiana is being noticed,” Greenstein says. “We were the first state to accept the March of Dimes’ challenge to reduce preterm births by 8 percent by 2014, and we received their Prematurity Leadership Award in July 2012. Louisiana’s efforts are a shining example that collaborative work can yield major gains to improve birth outcomes.”